Neighborhood Vitals: An Etymology

Epistemic Disclosure: I have strong interest but low certainty on this piece. I am actively investigating, talking about and refining my thinking on how to structure my work on Neighborhood Vitals. I have spent about a year researching “the vitals” themselves but have only read one source (included) on the history of human vitals. From conversation, I have a high degree of confidence that this phrase at least paints the right picture in people’s minds.

I’ve come full circle on what to call my current research.

In 2013 I wrote a concept note called The New Urban Vitals. It was an argument for measuring air quality, nutritional density of school snacks, availability of handwashing facilities, water quality and a few other indicators at local schools in the dense informal settlements where I worked in healthcare provision.

The classic vitals tell us if an individual’s body is in a state of crisis. The New Urban Vitals would tell us if a community is in a state of (health-related) crisis. The school is the logical place to measure the New Urban Vitals: 43% of Kenyans are under 15 years old. These readings would help us prevent, not react to healthcare events.

With mentorship from Ashoka and funding from Grand Challenges Canada, I built some traction around this idea. We set-up two initial Healthy Schools representing around 200 children, took their vitals and intervened where we could to improve conditions. It was incredibly effective, but never quite fit into our business at Access Afya so it fizzled out over the years.


Last year I handed over the executive role at Access Afya. My mind came back to the vitals of a place.

My first inclination was to change my working title from the New Urban Vitals to The Sixth Vital.

That was loaded.

First, attempts to add new vitals range from forgettable to catastrophic.

Lauren Siebel wrote a great overview about our vitals, how we got them, and the many lukewarm attempts to add more. There is broad consensus on the “core four”: blood pressure, temperature, pulse, breathing rate. Some doctors consider pulse oximetry to be one. Some ask about, and others emphatically reject pain. (The campaign for “pain as the fifth vital sign” is a particularly interesting read on mixed incentives) There have been attempts to add health literacy, or nutritional status.

It’s all important. But making too many things “vital” kind of takes the weight out of the word. And I didn’t want my work to fall into that trap.

Second, I was thinking of my “sixth vital” as an index of a wide range of environmental health factors: pollution, uranium exposure, soil properties, green space, community services, street lights. The list would go on, with relevant data coming together into an environmental health index.

Is trying to pass an index off as one vital “cheating”?

Probably.

With people, the framing of “vitals” as the core things you have to look at to know if a person is in a state of crisis makes sense. Maybe we do need this simplicity and focus for the New Urban Vitals, which I’ve now coined: Neighborhood Vitals. Neighborhood Vitals aren’t tacked onto the end of the human ones, they are their own set of measurable data points. I’m inclined to get the list down to just four or five.

If there were really just a few Neighborhood Vitals, would that help move people towards acting on them when they are “in the red?”

As an entrepreneur, I’ve got a bias towards action. I don’t want to build one more thing that tells us that some neighborhoods are “worse off” than others. I am working to develop a system for measuring the health of a neighborhood that could be implemented on a near-universal basis (for a low cost relative to the data/ value) and would signal that a known action needs to take place. A tree planted. A stop sign converted into a roundabout.

Neighborhood Vitals sit at the intersection of three things: 

  • Data points we can measure for a (relatively) low cost 

  • Data points with a clear relationship to individual and community health and safety outcomes 

  • Data points that have corresponding interventions. We do not want to measure “poverty” — rather trees.

Who takes that action? It will most likely come down to communities or governments. (To be continued in the next note...)

Related:

  • Neighborhood Vitals: My first essay launching the outline for my research.

  • Neighborhood Vitals in Practice: My first blog post documenting examples of individuals and organizations who are measuring Neighborhood Vitals types of data, and creatively implementing strategies to improve community health.

Cover Photo by Hu Chen on Unsplash

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